Breast Cancer Medical Surgical Nursing
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Transcript of Breast Cancer Medical Surgical Nursing
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Breast Cancer Medical Surgical Nursing
Posted by RNspeak on February 3, 2012 in Medical Surgical Nursing
1
Breast cancer is a malignant tumor that has developed from cells in the breast.Its usually begins with a formation of a small,
confined tumor (lump), or as calcium deposits (microcalcifications) and then spreads through channels to the lymph nodes or
through the blood stream to other organs. The tumor may also grow and invade tissue around the breast, such as the skin or chest
wall. Different types of breast cancer grow and spread at different rates, some take years to spread beyond the breast while other
move quickly.
Incidence
About 39,510 women will die from breast cancer in the U.S. according to American Cancer Societys most recent estimates as
of 2012 . Death rates have been decreasing since 1990 ,especially in women under 50.These decreases are thought to be the result
of treatment advances, earlier detection through screening, and increased awareness.In Asia, the Philippines is among the countries with the highest age standardized incidence rate for breast cancer. Survival rate
forbreast cancer in the Philippines is below 40 percent compared to the high survival rates of 80-98 percent already achieved
in developed countries.
Risk factors
Family History of Breast cancer- A womans mother diagnosed with breast cancer before the age of 60 or she had a sister or
daugther with breast cancer, her chance of developing a breast malignancy increases substantially.
Hormone Replacement Therapy- Taking estrogen supplements for menopause for lengthy period of times are at some
increased risk for development of breast malignancies. While the addition of estrogen and progesterone as a hormone supplement
may decrease the occurrence of endometrial cancer, it does not appear to decrease the risk of breast cancer.
Menstrual cycle-Women menses began before age of 12 and Do not experience menopause until after 55 of age have anincreased risk for breast cancer
Pregnacy after Thirty-Women who do not give birth to their first child until after thirty years of age,seem to have nearly twice
the risk of developing breast cancer than women who gave birth to their first child before twenty years of age.
Radiation Exposure-A Woman who has been exposed to ionizing radiation between puberty and thiry years of age has twice the
risk of developing malignant breast cells, than an individual that is not exposed to radiation or exposed at later time in life.
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BRCA-1 or BRCA-2 genetic mutation- found risk of developing breast cancer.These genes normally produce proteins that
protect from cancer. If a parent passes a defective gene, Women have 85% chance of getting breast cancer sometime during their
life.
Alcohol Intake-Alcohol intake also has not been conclusively shown to increase a woman risk of breast cancer. Although studies
show a slight increase in women who consume one drink a day and a greater increase among woman averaging three drinks
daily.
Stages of Breast Cancer
Stage Definition
Stage
0
Cancer cells remain inside the breast duct, without invasion into normal adjacent
breast tissue.
Stage
I
Cancer is 2 centimeters or less and is confined to the breast (lymph nodes areclear).
Stage
IIA
No tumor can be found in the breast, but cancer cells are found in theaxillary lymph nodes (thelymph nodes under the arm)
OR
the tumor measures 2 centimeters or smaller and has spread to the axillary lymphnodes
OR
the tumor is larger than 2 but no larger than 5 centimeters and has not spread tothe axillary lymph nodes.
Stage
IIB
The tumor is larger than 2 but no larger than 5 centimeters and has spread to the
axillary lymph nodes
ORthe tumor is larger than 5 centimeters but has not spread to the axillary lymph
nodes.
Stage
IIIA
No tumor is found in the breast. Cancer is found in axillary lymph nodes that aresticking together or to other structures, or cancer may be found in lymph
nodes near the breastbone
ORthe tumor is any size. Cancer has spread to the axillary lymph nodes, which are
sticking together or to other structures, or cancer may be found in lymph
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Asse
ssme
nt
The
patie
nt
most
often
repor
ts
that
she
detec
ted a
painl
ess
lump
or
mass
in
her
breas
t of
that
she
noticed a thickening of breast tissue. Otherwise the disease most appears on a mammogram before a lesion becomes palpable.Thepatients health history may indicate several significant risk factors for breast cancer.
Inspection of the patients breast may reveal
Clear, milky or bloody nipple discharge Nipple retraction,scanly skin around the nipple Skin changes such as dimpling, peau d orange or inflammation. Arm edema which is also identified on inspection may indicate advance nodal involvement.
Palpation may identify
A hard lump mass or thickening of breast tissue
Palpitation of cervical supraclavicular and axillary nodes may also disclose lumps or enlargement.Diagnostic test
Mammography the essential test for breast cancer can detect a tumor too small to palpate Galactography is a procedure in which radioactive dye is injected into the areola before performing a mammogram.This
procedure is performed when bloody nipple discharge is present.
Fine-needle aspiration and excisional biopsy provide cells for histologic examination to confirm the diagnosis. Chest X-rays can pipoint metastases in the chest Laboratory test such as alkaline phosphatase levels and liver function can undercover distant metastases
nodes near the breastbone.
Stage
IIIB
The tumor may be any size and has spread to the chest wall and/or skin of the
breastAND
may have spread to axillary lymph nodes that are clumped together or sticking toother structures, or cancer may have spread to lymph nodes near the
breastbone.Inflammatory breast cancer is considered at least stage IIIB.
Stage
IIIC
There may either be no sign of cancer in the breast or a tumor may be any size
and may have spread to the chest wall and/or the skin of the breastAND
the cancer has spread to lymph nodes either above or below the collarboneANDthe cancer may have spread to axillary lymph nodes or to lymph nodes near the
breastbone.
Stage
IV The cancer has spreador metastasizedto other parts of the body.
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Hormonal receptor assay can determine whether the tumor is estrogen or progesterone dependent.This test guidesdecisions to use therapy that blocks the action of the estrogen hormone that support tumor growth.
Treatment of Breast cancer
Surgery
Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:
Lumpectomy- Surgery to remove a tumor and a small amount of normal tissue around it. Partial mastectomy-Surgery to remove the part of the breast that has cancer and some normal tissue around it. The lining
over the chest muscles below the cancer may also be removed. This procedure is also called a segmental mastectomy.
Total mastectomy- Surgery to remove the whole breast that has cancer. This procedure is also called a simplemastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or
after. This is done through a separate incision.
Modified radical mastectomy-Surgery to remove the whole breast that has cancer, many of the lymph nodes under thearm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Chemotherapy may be given before surgery to remove the tumor. When given before surgery, chemotherapy will shrink the
tumor and reduce the amount of tissue that needs to be removed during surgery. Treatment given before surgery is
called neoadjuvant therapy.
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph
node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A
radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to
the lymph nodes. The first lymph node to receive the substance or dye is removed.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them
from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send
radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters
that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer
being treated
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping
them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and
can reach cancer cells throughout the body. The way the chemotherapy is given depends on the type and stage of the cancer being
treated
Target Treaments
Targeted treatments are drugs that attack specific cell mechanisms thought to be important for cancer cell survival and growth.
This specific targeting helps spare healthy tissues and causes less severe side effects than chemotherapy.
Trastuzumab (Herceptin) is one example of a targeted treatment designed for women whose tumor cells are HER2-positive. Sincetrastuzumab was approved, women with HER2-positive tumors are living significantly longer.
Hormone Blockers
These treatments prevent estrogen from attaching to receptors on breast cancer cells. As a result, estrogen cannot get in the cells,
and tumor growth is slowed. The treatments also reduce the amount of hormones circulating in the body that attach to estrogen or
progesterone receptors. By blocking hormones, the treatments deprive tumor cells of the substances they need to grow.
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Tamoxifen (Nolvadex) is the standard estrogen blocking treatment for most premenopausal women. Tamoxifen is also effective
for postmenopausal women
Nursing Intervention
Always evaluate the patients feelings about her illness and determine her level of knowledge and expectations. Administer analgesics for pain as needed. Perform comfort measures to promote relaxation and to relieve anxiety. If immobility develops late in the disease, prevent complications by frequently repositioning the patient, using a
convoluted foam mattress.
Provide skin care particularly in bony prominences. Provide measures to relive adverse effects of treatment. Instruct the patient or caregiver how to manage adverse effects of treatment. Watch for treatment complications, such as nausea, vomiting, anorexia, leucopenia, thrombocytopenia, gastrointestinal
ulceration, and bleeding.
Monitor patients weight and nutritional intake for evidence of malnutrition. Inspect the skin for redness, irritation, and skin breakdown if immobility occurs. In late disease, monitor the patients pain level and the efficacy of administered analgesics and non-pharmacologic
measures.
Assess the patients and familys ability to cope, especially if the cancer is terminal.Patient teaching
Provide clear,concise explanation of all procedure and prescribed treaments. Instruct the patient or caregiver how to manage adverse effects of treament Explain the benifits and limitations of breast self examination.If patient chooses to perform the procedure teach her how to
examine her breast
Women who have had breast cancer in one breast are higher risk for cancer in the other breast or for recurrent cancer inthe chest wall.Therefore,urge the patient to continue examinig the other breast and to comply with follow up treamnet.
Refer the patient and family to hospital and community support services.